Figure 1. Pick your pace in MIPS: If you choose the MIPS track of the
Quality Payment Program, you have three options.
Source: Centers for Medicare and Medicaid Services. The Quality Payment Program Overview
Fact Sheet. Available at: https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_
Fact_Sheet.pdf. Accessed November 28, 2016.
Figure 2. 2017 MIPS Performance Category Weight
a final score of 70 or higher will be
eligible for the exceptional performance adjustment, funded from a
pool of $500 million. 1
How Is MIPS Performance Calculated?
First, each of the four categories will
receive an individual performance
score. An overall composite score will
then be assigned based on the summed
performance in all categories. The final
score is the sum of each of the products
of each performance category score and
each performance category’s assigned
weight, multiplied by 100. The final rule
outlines methodology for calculating
performance scores for each category.
If a MIPS eligible clinician or group believes their MIPS score has been unfairly
calculated, they have a 60-day period to
submit a request for a “targeted review”
or appeal to CMS.
For payment year 2019, based on performance in 2017, CMS assigned the following weights to performance categories
n Quality: 60%
n Improvement Activities: 15%
n Advancing Care Information: 25%
n Cost: 0%
For the first year of MIPS, CMS will not
be assigning weight to the Cost category.
However, by payment year 2021, it is
anticipated to increase to 30%. To accommodate the increasing cost threshold, weights in the other categories will
What are the Bonuses and Penalties?
n Payment Year 2019: Maximum
penalties and bonuses are 4%.
n Payment Year 2020: Maximum
penalties and bonuses are 5%.
n Payment Year 2021: Maximum
penalties and bonuses are 7%.
n Payment Year 2022 and beyond: Max-
imum penalties and bonuses are 9%.
Since MIPS is a budget neutral program,
Track 2—Alternative Payment
bonuses and penalties must balance. For
years 2019 to 2024, eligible clinicians
whose composite scores fall above the
threshold may be eligible for additional
bonuses of up to three times the pay-
ment adjustment amount for each pay-
ment year (Figure 3). Additional money
is also available to eligible clinicians who
fall in the “exceptional performance”
category. MACRA legislation defines
an “exceptional performance” bonus
pool of up to $500 million per payment
year from 2019 to 2024 to be awarded to
the eligible clinicians who receive the
Track two, or participation in an
alternative payment model (APM),
centers on incentivizing providers based
on quality metrics, outcomes and cost
efficiency. As discussed earlier in this
article, HHS has set explicit goals for
tying participation in eligible APMs